Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.143
Peer-review started: August 12, 2022
First decision: October 12, 2022
Revised: November 1, 2022
Accepted: December 9, 2022
Article in press: December 9, 2022
Published online: January 6, 2023
Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence. They require immediate and appropriate management before they progress to an irreversible condition. Although negative pressure wound therapy (NPWT) can prevent wound progression by increasing microcirculation, the inappropriate application of NPWT on complication-threatened transferred and replanted tissues can induce an adverse effect.
A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap. While applying a heating pad directly to the flap site, she sustained a deep second to third-degree contact burn over 30% of the transferred flap on postoperative 7 d. As the necrotic changes had progressed, we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d. After 4 d of NPWT application, the exposed fatty tissues of the flap changed to dry and brown-colored necrotic tissues. Upon further debridement, we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.
Although NPWT has been shown to be successful for treating various wound types, the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
Core Tip: Negative pressure wound therapy (NPWT) is the effective promotion of survival in free tissue transfer, but special attention is required in cases of burn injury over the transferred flap site. Microsurgeons should be cautious about location of the pedicle, pressure and mode when using NPWT at burned site over transferred free flap tissue.